It is important to reiterate what HIV susceptibility and AIDS vulnerability entail. According to Loevinsohn and Gillespie (2003), the likelihood of becoming infected with HIV is referred to as susceptibility. This is determined by such factors as the economic and social conditions of a society or community, power relationships between groups, livelihood strategies, culture and gender, and biological factors (DeWaal and Tumushabe, 2003; Haddad and Gillespie, 2001; Stokes, 2003; TANGO, 2003). The likelihood of suffering adverse consequences as a result of HIV and AIDS, including chronic illnesses and death, is labelled as vulnerability.
This is determined by, amongst other things, poverty, power relations, gender inequality, and fragmented community and household structures (Kadiyala and Gillespie, 2003).
Vulnerability to HIV and AIDS results from a combination of pre-existing conditions in the livelihoods of individuals and households, leading to different levels and forms of coping and resilience. Hence, “insecure livelihoods exacerbate the risk and vulnerability environment for HIV and AIDS” (Drimie and Mullins, 2005:2). AIDS-associated illnesses and deaths undermine livelihood options, which forces affected households to make decisions which involve tradeoffs between basic needs (Drimie, 2003; Drimie and Gandure, 2005, Kadiyala and Gillespie, 2003). Nioef et al. (2010) argue that while there have been significant medical advances in understanding and responding to HIV and AIDS, the wider set of social and economic conditions animating the HIV epidemic and the multiple downstream impacts of AIDS on societies are less well-known.
121 The research on Chivanhu settlement is intended to deepen our understanding on these matters. The kinds of interaction between the pandemic on the one hand and HIV/AIDS- affected individuals and households on the other is shaped and mediated through and by time (Ziervogel and Drimie, 2008). There are three broad identifiable phases in HIV susceptibility and AIDS vulnerability which warrant attention (Gillespie, 2006), and the chapter is designed to discuss these in relation to Chivanhu. First of all, there is the upstream phase relating to the risk of an individual becoming exposed to and infected with HIV; secondly, there is the midstream phase during which individuals are at risk of developing opportunistic infections after HIV infection; and, thirdly, there is the downstream phase involving the risk of serious impacts on households and communities affected by the pandemic. Each of the three different phases has particular conditions of existence and particular consequences, and there is the possibility of a vicious cycle as the impacts of AIDS vulnerability may in turn increase the risk of HIV susceptibility.
6.2.1 Upstream phase factors which create HIV susceptibility in Chivanhu settlement This section discusses the factors that create conditions for susceptibility to HIV infection in Chivanhu settlement. In relation to most of the factors, specific case studies of individuals and households in Chivanhu are presented and discussed which identify the working out of the factors that predispose individuals to HIV or increase the risk of getting HIV infection. The factors that influence susceptibility in the upstream phase include: high levels of social and livelihood insecurity, gender and social inequalities, power relations, intergenerational sexual relationships, multiple concurrent partnerships and inefficient governance institutions.
However, as presented in the case studies, some of the factors that influence susceptibility are also similar to factors that will influence vulnerability in the middle and downstream phases.
In the case studies, these conditions facilitating HIV infection often become manifested jointly or in combination and lead to the complex character and vicious cycle marking HIV infections and progression to AIDS.
6.2.1.1 Unstable marriage unions
In the context of unstable marital unions, this sub-section highlights the significance for women of livelihood insecurity in being susceptible to HIV, by presenting five case histories.
The case histories show the ways in which livelihood and food insecurity along gender lines produce conditions which enhance the prospects that women (and men) will enter risky livelihood coping activities leading to HIV infection. The first life history is of a woman
122 (Susie) who resorted to having multiple boyfriends after her husband’s death; the second is of a woman (Hesi) who resorted to commercial sex work after her divorce; and the third case is of a man (Govo) who engaged in gold panning around nearby Mashava Mine and was highly migratory and engaging in risky casual sex. I first outline their stories briefly and then comment on them together.
Susie, aged 36, was infected with HIV because of her various relationships after the death of two husbands. She relates her story as follows:
My first husband died and left me with two children to look after. I remarried after two years and I have a child from the relationship. My second husband died after about two years together. All my three children are currently going to school and they are supported under the BEAM programme. I have tested HIV positive, although I am not yet on ART, because my CD4 count is still high. I have boyfriends who provide me with different kinds of support and some of them are concurrent. Most married women in this settlement feel threatened by me and they think I am spreading HIV to their husbands. I need these relationships so that I can survive. This year I did not get anything from my agricultural plot because of rainfall shortages, but I still need to provide food for my children.
Hesi, a 47-year old woman, relates a similar story:
I was married to a headmaster and I was divorced because I was accused of being a witch. I tried to claim maintenance from him so that the children could go to school but I was unsuccessful. The pressure of finding money for survival, forced me to join my sister who was surviving through commercial sex work. For me it was the only alternative means of earning an income to look after myself and my children, and now I am HIV positive.
Govo is aged 42 and he tested positive for HIV in 2008. He was engaged in gold panning around Mashava Mine about thirty kilometres from Chivanhu. Certain women from different places in Masvingo Province would come to sell foodstuffs in the mining area and some of them would spend overnights in the makorokoza area. Govo and a number of other men, often under the influence of alcohol, would take advantage of this arrangement and sleep with the women. They would often exchange women and he has passed on the HIV infection to his wife such that she is also now HIV positive. At the moment Govo and his wife are not yet
123 bedridden; and they are surviving through gardening and the husband is also involved in brick making. When the wife discovered that she was HIV positive, she went to her parental home.
Whilst she was at her parents’ home, Govo’s wife fell in love with another man, and became pregnant with a child. The love relationship did not last long and she came back to reunite with Govo. The child from the other relationship while she was estranged from Govo is also HIV positive.
In Chivanhu settlement, the average land holdings are too small for a household to engage in sustainable agricultural production and income-generating opportunities are limited for the majority of the households. There is chronic food insecurity because of this, and throughout the year. As a result, many livelihood strategies adopted by various household members increase their risk of HIV infection. Some men, with influence or resources (like Govo), take advantage of the dire livelihood circumstances of women (such as Susie and Hesi) and request sexual favours in return for assisting them. Because of their economic and social dependence on men, women report that they have difficulties in saying no to unprotected sex.
Most of the women and young girls living in Chivanhu have few opportunities for pursuing a sustainable livelihood and they have few (and often no) assets to dispose of, or to derive a livelihood from, in order to cope with day-to-day living. With limited financial resources to begin with, vulnerable young women and adult women mostly engage in transactional sexual relationships with men to survive. In this context, the women in the two cases would resort to transactional sexual relationships or commercial sex work. Men also are not spared from the risks of HIV infection. The Govo case shows that migratory livelihood strategies like gold panning, where there are the likelihood of alcohol and casual sex, increase the HIV susceptibility of the men and their partners.
The next three examples bring to the fore more clearly the significance of unstable marriage unions in terms of generating susceptibility to HIV, and how this links to the pursuit of livelihood security. The following case histories involve, firstly, a woman and man who are in a long-term monogamous union and at the same time both of them have concurrent sexual relationships with other partners. The second case is of an elderly man who is in a permanent marital relationship with a much younger woman. He is having serious challenges providing materially for the woman and his wife has several transactional relationships with other men in the settlement. The third case history involves a woman whose husband engages in
124 transactional sexual relationships with women who want fish from him. The cases show the various complexities between unstable marital unions, unsustainable livelihoods and HIV infection risks.
Chando is a woman aged 36 who is involved in commercial sex work. Chando’s regular boyfriend who claims to be her official husband John went to Zambia looking for work and, when he returned, he found Chando engaged in sex work. Chando says that she is a sex worker in order to provide food for her children. She claims that she did not become infected through sex work, but was infected by her regular lover on his return from Zambia in 2010.
She has six children, two with John and the other four children with four different men. At the moment the husband is currently hospitalised; he is bed-ridden and the children are not going to school. Chando stays at Nemanwa the growth point where she is a caretaker for a house which is being built.
Born in 1918, Zekie is very old and he cannot engage in any activities to support or assist him. He is married to a young wife and he has eight children, five of his own and three from his current wife. He is from the Johane Masowe religious sect and he used to be a prophet;
through this, he managed to marry a very young wife. The wife is engaging in multiple extra- marital affairs saying that the husband is very old and that she wants younger men of her age.
On several occasions, I witnessed disputes between the husband and the wife being handled by the village head. The young wife is chronically ill and the eldest son of Zekie (from his current wife) and the son’s own wife sides with his mother (Zekie’s wife) in these disputes. If Zekie complains, the eldest son tells his father to keep quiet because the mother is the breadwinner. The boy was married in early 2011 and the mother paid lobola for him. The second eldest child, who is around 17, no longer goes to school and she is involved in commercial sex work. She brings her patrons to the homestead and the father cannot reprimand her, because if he decides to reprimand her, he is threatened by his eldest son with his wife and his own wife. The family chronically experiences food shortages.
All five cases in their own way show that HIV transmission in Chivanhu settlement is embedded in complex social networks, which in turn are intricately linked to livelihood insecurity and to the general day-to-day livelihood coping strategies of individuals and households. This connects to the cultural position of women in marriages in Chivanhu and elsewhere in rural Zimbabwe. Culturally the subordinate position of women prevails, for
125 instance through the payment of lobola by men for their wives. This animates the marital relationship – marriage produces and maintains conditions and mechanisms which lead to male abuse of authority and control and which affect women‘s powers of negotiation on sexual matters. Common narratives from my fieldwork show women as victims of men’s risky sexual behaviour. Women at times seek to use their prospects of sexual liaisons with men to facilitate livelihoods, though not as equal partners. Therefore, the sexual behaviour of both males and females is critical for increasing the likelihood of HIV risk. Where marital or long-term unions are unstable and spouses are straddling between stable unions on the one hand and being part of a larger sexual network on the other hand, a fertile ground for HIV arises.
Although these cases depict that HIV risk for women is influenced by the sexual behaviour of their male partners, in these cases the sexual ideas and practices of the females vis-à-vis HIV also increases the HIV risk for themselves and their regular partners as well. Most married women in Chivanhu believe that marriage protects one from HIV infection and, even though the women knew (and accepted it if only in terms of compliance) that their husbands had extramarital affairs, they held a low risk perception and hence they reported that they did not demand protection from their husbands. According to a claim from one wife,
People believe marriage is a safe haven and they are not taking precautions or insist on safer sex.
Another woman indicated:
The challenge is if we are associating with each other for more than three months, we are no longer using condoms, even if we have not undergone HIV testing. Although sex workers are considered to be a serious risk, as women most of us we do not think that our husbands can pass on the HIV virus to me.
Most men commented that after associating with a woman for three months or more (whether a casual relationship or not), they assumed that their partner was safe (or HIV negative) and they stopped using condoms in their sexual encounters. Most men stopped using precautions even if he and his partner had not both undergone HIV testing.
126 HIV positive women in permanent relationships noted that most men do not want to hear about condoms despite the fact that the men know about the challenges of re-infection16. For these women, who were aware of the personal risks to themselves, protecting themselves from further re-infection was a daily challenge but the possibilities of demanding the usages of condoms was remote. For discordant couples, HIV positive women reported the burden of the added stigma associated with their HIV status. In the event of the wife being positive and the husband negative, divorce ensued. As a result, most HIV positive women who had undergone HIV testing would not disclose their HIV status to their partners. As one woman put it:
Man positive, woman positive that is an acceptable scenario, but man negative and wife positive, that is an unacceptable scenario, in most families.
Despite the fact that women are powerless to negotiate in favour of safe sex and condom usage, they are the ones who experience the most negative experiences in the event of becoming HIV infected.
6.2.1.2 Intergenerational sexual relationships
Closely related to the points in the previous section are intergenerational relationships between girls (or young women) and older males which are also linked to livelihood insecurity. These are common in Chivanhu, and the two case histories here show how young women are subject to increased risk of HIV infection arising from these relations. The limited local livelihood opportunities force some women to migrate to South Africa, leaving their children in the custody of elderly people or in some cases on their own. Some of the minor girls in these circumstances would resort to transactional sexual relationships with adult males, while others are encouraged by their grandmothers to resort to commercial sex work as depicted in the following case histories. The first case is of an elderly-headed household where the grandmother was encouraging her five teenage grandchildren to engage in transactional sexual relationships in order to access food and other basic commodities. The second case is of a minor who is left behind when her mother goes to South Africa and she is now HIV positive as a result of transactional sex.
Mbuya Mai Ruu has five grandchildren and the household is in state of chronic food insecurity. According to other concerned community members:
16 Even if both partners are HIV positive, they are encouraged to always use condoms because the HIV strains that they have might be different. If they do not use condoms correctly and consistently, chances are they might re-infect each other with a different HIV strain and that can have serious health consequences.
127 Grandmother, she stays with her grandchildren. The old lady has a habit of encouraging her grandchildren to engage in transactional sexual relationships. At the moment all five of her grandchildren are HIV positive: two are in their teens and three are in their early twenties. At one time we reported her to the chief, but she never repented from her behaviour. Now that the grandchildren are HIV positive she wants to chase them away saying that they should go and search for their relatives from the fathers’ side.
The transactional sexual relationships that these five grandchildren are involved in are not with young men of their age group but involve much older men. In this respect, for many girls and young women who are experiencing livelihood insecurity challenges, the proximity of the settlement to Great Zimbabwe Monuments (a tourist resort) and the Harare-Beitbridge highway leading to South Africa, facilitates transactional and commercial sex work as alternative livelihood strategies, while at the same time increasing their risk of HIV infections.
Some young girls (as young as sixteen) were going to Masvingo and operating from a certain house there, offering their sexual services to the older truckers passing through Masvingo.
Mpo is fifteen years old and attends Form Three at the local secondary school. During the time of conducting the research, Mpo’s mother and father were separated; both of them are working in South Africa and they send money back to Mpo intermittently. She is staying with her aunt in Chivanhu but the aunt is not able to control her wayward behaviour. Mpo is HIV positive (she was tested at the mobile Population Services International (PSI17 clinic in 2010).
At the time of testing she was asked to bring her guardians, but she could not go with her mother because the latter was in South Africa. She is ‘sleeping around’ with anyone from boys to adult men. At one time, I witnessed a dispute with one of the neighbours because she was engaging in sexual relations with the seventeen year-old nephew of a man named Machekeche (who is enrolled in Upper Six in nearby Zaka) as well as with Machekeche’s married young brother who is aged 26 and resides in Harare. The 26 year-old was found sleeping in the same house with Mpo. At the same time, Machekeche’s two wives were complaining that he was also co-habiting with Mop’s mother in South Africa. When Machekeche and the other community members were discussing and deliberating on the issue, they were more worried that Mpo might pass the HIV infection to their nephew and married brother than on the abuse the young girl was suffering. Many community members (mostly
17 PSI is an NGO specialising in HIV and AIDS services; they conduct mobile visits to areas where voluntary HIV and AIDS testing is limited and provide the HIV testing and counselling services.